术中实时超声在颅内胶质瘤显微手术切除中的应用  

Application of real-time ultrasonography in the resection of intracranial glioma under microscope

作　　者：苏忠周[1] 韩运生[2] 周跃[1] 陈钟樑[1] 沈亮[1] 

机构地区：[1]浙江省湖州市中心医院神经外科,浙江湖州313000 [2]浙江省湖州市中心医院超声科,浙江湖州313000

出　　处：《中国现代医生》2016年第27期95-97,101,F0003,共5页China Modern Doctor

基　　金：浙江省科技厅公益技术研究社会发展项目(2016C33220)

摘　　要：目的 探讨术中实时超声在颅内胶质瘤显微手术中定位、引导肿瘤切除及实时监测肿瘤切除范围的应用价值。方法 回顾性分析2011年6月-2015年8月入住我院的颅内胶质瘤显微手术患者74例,根据术中是否超声引导分为超声组（39例）和对照组（35例）,超声组使用术中超声扫描定位肿瘤,了解病灶的大小范围、形态与周围结构的关系,选择合理的手术入路和皮层切口并监测肿瘤切除范围,对照组术中未使用超声,对比分析两组肿瘤定位准确率及全切率,同时记录术后颅内感染、脑挫伤等并发症情况。结果 超声组肿瘤定位准确率高于未用超声组（100.0%vs 82.9%,P〈0.05）,超声组肿瘤全切率高于对照组（82.1%vs 51.4%,P〈0.05）。超声组无颅内感染、脑挫伤等相关并发症发生。结论 应用术中超声技术切除颅内胶质瘤具有定位准确、有效保护重要结构和大血管、实时监测肿瘤切除范围等优点,可提高手术全切率,减少术后并发症发生。Objective To discuss the application value of intraoperative real-time ultrasonography in the localization of intracranial glioma mierosurgery, guided resection of tumor and real-time monitoring of the range of tumor resection. Methods A toital of 74 patients with intracranial glioma who were admitted to our hospital and given intracranial glioma microsurgery from June 2011 to August 2015 were retrospectively analyzed. The patients were divided into the ultrasound group（n=39） and the control group（n=35） according to whether ultrasound was performed during the surgery. Intraoperative ultrasound scanning was applied in the ultrasound group to locate the tumor, so as to understand the size of the lesion, morphology and the relationship with surrounding structures. A reasonable surgical approach and cortical incision were selected and tumor resection range was monitored. No intraoperative ultrasound was applied in the control group. The accuracy of the tumor location and the rate of total resection were compared and analyzed, and the complications such as intracranial infection and cerebral contusion after the surgery were recorded. Results The accuracy of tumor localization in the ultrasound group was higher than that in the non-ultrasound group（100.0% vs 82.9%, P〈0.05）. The rate of total tumor resection in the ultrasound group was higher than that in the control group（82.1% vs 51.4%, P〈0.05）. There was no intracranial infection or cerebral contusion or other complications in the ultrasound group. Conclusion Intraoperative ultrasound resection of intraeranial glioma has the advantages of accurate positioning, effective protection of important structures and large blood vessels, real-time monitoring of tumor resection range, which improves the rate of total surgical resection and reduce postoperative complications.

关 键 词：脑胶质瘤 显微手术 术中超声 准确率 全切率 

分 类 号：R445.1[医药卫生—影像医学与核医学] R651[医药卫生—诊断学]